A Prescription for Achieving Deeper Involvement in eHealth – Learning Medicalese

H. Dominic Covvey, National Institutes of Health Informatics

Learning Medicalese2Anxiolytic, renal, cholecystectomy, angina, syndrome, morbidity, urticaria …and the ‘f-words’ like fibromyalgia and fibula! For healthcare providers, they are their Lingua Franca, but for some of us who aspire to work with those healthcare providers they might as well be Klingon.

The truth is that few of us have had the opportunity to study medicine or any of the other health sciences and, consequently, we often lack the vocabulary needed to understand and communicate with healthcare providers.

It isn’t just the words, either. It’s understanding the healthcare system and its internal operations, appreciating the nature of clinical practice including diagnosis and treatment, and comprehending what health, wellness, disease and treatment are about. Lacking this knowledge, we are impaired in deeply understanding the challenges the system and its providers face, the constraints under which the system exists, and the patients and their needs that the healthcare system addresses.

What can we do about this impairment?

Well, we could go back to school — not an option for most of us. Or we could take a whole bunch of courses like Anatomy, Physiology, Pathology and the nature of the Canadian health system. But even that is beyond the effort that most can make. I guess it is possible to pursue this kind of knowledge through the Web and it’s amazing resources, or through reading selected books, but if you don’t know what to look for and if you don’t find things that are interesting and instructive, that effort will quickly burn out.

There’s no better way to understand something than having to teach it.

There are other options, but they almost certainly require a mentor, someone who can lead you through the forest of information and point out events and materials that will sustain an adequate degree of interest. Maybe also, it will be possible to find a sort of one-stop shopping mall for the basic knowledge of medicine and the health system. An online series put on by NIHI does just that.


What is it that we need to know?

Having faced this challenge myself, I can tell you what worked for me. I came into the field of Health Informatics from the disciplines of Physics, Astrophysics and Biophysics in that order. Very early on, I realized that to succeed as a researcher I would have to be able to read the medical literature. Boy, was that a challenge! First of all, I had to look up almost every word in articles. There was the other fact that medical writing in the 1960s was mostly descriptive and often was limited to case studies. Compared to the scientific literature with which I was familiar, it was dead boring, too! I started reading with a dictionary handy and got quite a bit of help from colleagues in Cardiology. My other secret weapon was marrying a radiologist. As you can imagine, the field of Medicine dominated our conversations and I could ask what things meant. Over the years, I accumulated a great deal of knowledge and did a bit of teaching — there’s no better way to understand something than having to teach it. However, short of marrying a physician, this is definitely a difficult row to hoe.

Excepting a somewhat self-centered approach to marriage, I think the following can serve as a guide in searching for materials or, if you have the time and resources, for courses:

  1. In the field of eHealth we need to know at least the major components of the body (very basic Anatomy) as they are named in the medical field — a bit differently from our pedestrian names like bellybutton, shoulder blade, heart, kidneys and so on. We need to know a bit about the skeleton of the body, its major organs, its circulatory and nervous systems, and a number of other body systems. It isn’t necessary to be able to name all the bones in the body, or to describe the microanatomy of the hand, but having a general knowledge and being what I call ‘medically literate’ is very helpful.
  1. It is also important to know a bit about how the components of the body function or at least what they do. For example, what the lungs, the kidneys, and the heart do. This area is called ‘Physiology’. Knowing a little bit will enable a person to start to read and to learn more over time.
  1. Then there is what happens when things go wrong, a subject called Pathology. It’s useful to at least understand some of the major diseases, what they’re caused by (like viruses or bacteria, inflammation, cancer, and so on) and bit about how they can be treated. Again, the emphasis should be on the ultra-basics and on both learning words and understanding what sickness is about.
  1. Because we work with care providers, what they do and how they function is important knowledge. Understanding how a patient is examined, why various tests are done, what diagnosis is about, how treatments are chosen, and how patients are followed up all will be of great help.
  1. The healthcare system is the realm in which wellness is managed and sickness is addressed. So, knowing about our healthcare system, what its components are, what the Health Act is about, how everything works together, and how it is all funded, will enlighten the individual and better enable him or her to function effectively in the healthcare system.
  1. Although not specific knowledge, it is important to learn these things in the context of cases: how patients present themselves. Over the years, I have found that my students were able to dig into this domain far more efficiently if they related their investigations to medical problems they, their families, or their friends had faced. This gave them a handle that stimulated and maintained their interest.


Where do we go from here?

I’ve sort of thrown down the gauntlet and challenged eHealth professionals to get in gear and learn as much as possible about the system in which we work, about those with whom we work, and about what health care is all about. The question is where should you start?

I have found that there are some very useful books available. They are often called ‘family medical guides’ and examples are available from Harvard Medical School, Stanford University Medical Center, and the Mayo Clinic. One of the best ones I have found is produced by the Canadian Medical Association and called ‘The CMA Family Medical Guide’. It isn’t very expensive and can be easily obtained either at a bookstore or Amazon. The nice thing about these family guides is that they are based on the idea that someone in your family has a problem that you need to know about, and you look up that problem. They are not books that you read from cover to cover. Rather they are curiosity-driven and, frankly, more interesting. They tend to use basic terminology and to teach key medical words. I am still looking for good books on the diagnosis and treatment process and on the Canadian healthcare system, but you can snoop for those and see what you find. I know at least one physician who is writing a book on the diagnosis-treatment process, but I don’t know when it will be available. This individual has often stated that he can teach students enough of the basics of Medicine that they can function as junior physicians! But, I think I’ll get my care from one of the certified ones.

If you are aware of materials relevant to this topic, I would like to hear from you. You can comment below with your thoughts. If you take the time to do that, I will recognize your contribution and share it with others.

I can tell you that you will almost certainly find what you learn about Medicine to be interesting and exciting. Besides, with the right words maybe you can find that medical mate I mentioned!

Dominic Covvey (FACMI, FHIMSS, FCIPS, SMIEEE, ITCP) is an Adjunct Professor at the University of Waterloo and the University of Ontario Institute of Technology. He is also the President and Director of the National Institutes of Health Informatics. He was the Founding Director of the Waterloo Institute for Health Informatics Research at the University of Waterloo (2003-2010). His research is in the representation and analysis of healthcare workflow, the definition of competencies and curricula in Health Informatics and the design of the Electronic Health Record.

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